High-intensity focused ultrasound treatment of unresectable soft tissue sarcoma and desmoid tumours - a systematic review

M Chetan; M Gillies; S Rehman; C McCarthy; T Cosker; F Wu; P C Lyon

doi:10.1016/j.crad.2025.106977

High-intensity focused ultrasound treatment of unresectable soft tissue sarcoma and desmoid tumours - a systematic review

Clin Radiol. 2025 Jun 2:87:106977. doi: 10.1016/j.crad.2025.106977. Online ahead of print.

Authors

M Chetan¹, M Gillies², S Rehman³, C McCarthy⁴, T Cosker⁵, F Wu⁶, P C Lyon⁷

Affiliations

¹ Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK. Electronic address: madhurima.chetan@doctors.net.uk.
² Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK. Electronic address: martin.gillies@nds.ox.ac.uk.
³ Department of Radiology, Sheikh Shakhbout Medical City, Abu Dhabi, UAE. Electronic address: dr.safiarehman@gmail.com.
⁴ Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK. Electronic address: catherinemccarthy@doctors.org.uk.
⁵ Department of Orthopaedics, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK. Electronic address: Thomas.Cosker@ouh.nhs.uk.
⁶ Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK. Electronic address: feng.wu@nds.ox.ac.uk.
⁷ Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK. Electronic address: paul.lyon@nds.ox.ac.uk.

PMID: 40570819
DOI: 10.1016/j.crad.2025.106977

Abstract

Aim: We review the evidence for high-intensity focused ultrasound (HIFU) in the treatment of soft tissue sarcoma (STS) and desmoid tumour (DT).

Materials and methods: We searched Embase, Medline, PubMed, and Google Scholar for relevant studies between 2000-2024 using search terms 'high intensity focused ultrasound' and 'sarcoma' or 'chordoma' or 'desmoid'. We extracted data on patient demographics and treatment outcomes.

Results: We identified 12 studies pertaining to STS (n=178) and 15 studies pertaining to DT (n=417). These were prospective phase I/II open-label trials and retrospective case series or reports. The commonest adverse effects were skin burns, transient pain, and fever. Less common adverse effects of nerve injury and bowel perforation were depended on anatomic relations of the tumour. The majority of patients treated had unresectable disease that was partially ablated with HIFU for the purpose of local control. There was a high degree of variability in the reporting of outcomes making quantitative analysis challenging.

Conclusion: The studied papers show that HIFU has a favourable safety profile with a potential role in patients with unresectable STS and DT. HIFU may confer advantages in cases of oligometastatic progression for disease control, complex anatomy including proximity to vital structures, recurrent cases in previously radiotherapy-exposed and/or operated locations with limited other locally-directed treatment options. However, there is limited reporting of the clinically important outcomes of recurrence and survival and further research is required, and this may represent an opportunity for later-phase trials in the UK and worldwide.